Preventing cervical cancer among HIV-positive women

Cervical cancer, caused by human papilloma virus (HPV), is a leading cause of cancer-related death among women in low-resource settings. Some areas with the high cervical cancer prevalence, such as sub-Saharan Africa, also have high HIV prevalence. Among HIV-positive women, a weakened immune system and inability to clear HPV may lead to an increased risk of cervical cancer; studies have found a 2- to 22-fold increase in the incidence of invasive cervical cancer among women living with HIV compared with the general population.

The high risk of cervical cancer among HIV-positive women underscores the urgent need for effective cervical cancer prevention programs tailored to their needs. To help develop such programs, researchers with the UCSF Bixby Center worked with a group of HIV-positive women with cervical cancer in Western Kenya. The researchers saw the women six and twelve months following a treatment to clear abnormal cervical cells. The treatment effectively reduced the risk of cancer for up to one year, with only 13% of women experiencing a return of cervical cancer. However, among the women who did experience a return of the disease, the researchers observed a high proportion of invasive cancer.

Because of the risk of developing invasive cancer after treatment, HIV-positive women should receive continued and close follow-up care for cervical cancer. However, the standard of care in low-resource settings means that many cases of invasive cervical cancer could be missed. For instance, without collecting specimen samples of cervical tissue, cases of invasive disease may be missed, especially among HIV-positive women. The researchers call for a continued investigation of the most cost-effective and feasible programs to prevent and treat cervical cancer worldwide.


Abortion and mental health issues unrelated

Although the relationship between abortion and mental health has been a topic of scientific debate and public interest for the past three decades, few studies have been designed to examine this relationship specifically. Researchers with the UCSF Bixby Center conducted a study to examine this relationship and fill this gap in the scientific literature.

Using data from the Turnaway Study, the researchers found that anxiety and depression were not more common among women having an abortion. Specifically: 

  • Among women who received an abortion, depression and anxiety symptoms remained steady or decreased over the 2 years after the procedure. 
  • Levels of anxiety symptoms were initially higher among those denied an abortion compared with those receiving one, but the two groups converged over time. 
  • Women who received abortion close to gestational age limits initially had similar levels of depression and lower levels of anxiety compared to women who were denied abortions and subsequently carried their pregnancies to term.

These findings show that relative to unwanted childbearing, abortion does not lead to an increased risk of mental health problems among women. Opponents of legalized abortion have suggested that abortion is a traumatic event with severe consequences for women’s mental health, but this study and others indicate definitively that abortion does not cause mental health issues. Policymakers should take this into account when legislating women’s access to safe and high-quality abortion care.


Effective contraception contributes to abortion declines in Iowa

There is growing evidence that increased use of highly effective contraception is associated with reductions in unintended pregnancies and abortion. New research from the UCSF Bixby Center examines whether increased access to intrauterine devices (IUDs) and implants in Iowa contributed to a decline in abortions in the state.

Between 2006 and 2008, access to family planning services increased in Iowa through a state Medicaid program and a privately funded initiative. During the same time, access to abortion expanded in Iowa through telemedicine provision of medical abortion. Even with this increased access to abortion services, the number of abortions in Iowa declined. Using data from more than 500,000 medical records, Bixby researchers found a strong connection between increases in IUD and implant use and the subsequent decline in abortions across Iowa. The researchers found that: 

  • A small increase of 1 new IUD or implant user per 100 women was associated with a 4% decline in abortion each year.
  • The decline happened in conjunction with an increase in the number of facilities offering abortion care to women, particularly in rural and remote areas

"To our knowledge, this is the first study to explore the relationship between IUD and implant use and reduction in abortion that was able to control for other factors, such as population density, poverty levels and the number of abortion clinics in a region,” Bixby Center researcher and lead study author Antonia Biggs said. “Our research adds to the growing body of evidence that an investment in highly effective family planning is money well spent.”

Given the increase in abortion access and lack of legal restrictions placed on abortion in Iowa from 2005 to 2012, the researchers concluded that reductions in abortions were not a result of laws restricting abortion access. These findings support the need to continuously provide women with access to safe and high-quality abortion and contraceptive services, which together help women plan for their and their families’ wellbeing.


Saving women’s lives in childbirth worldwide

Too many women around the world face the risk of death or disability from childbirth, and the UCSF Bixby Center is conducting groundbreaking research to make childbirth safer. Bixby Center researcher Suellen Miller recently discussed how the Safe Motherhood Program, which she founded in 2003, pioneered use of the Non-pneumatic Anti-shock Garment (NASG). The NASG is a first-aid device to stabilize women suffering from obstetric hemorrhage and shock, the leading cause of maternal death during which a woman bleeds heavily after giving birth.

In a new interview with WBAI Pacifica Radio’s “Healthstyles,” Miller discusses how the NASG helps reduce maternal mortality by 50 percent. The NASG can be applied by anyone after a short, simple training, and has been used by over 9,000 women in 20 countries. Miller also talks about how the SafeMotherhood Program partners with nongovernmental organizations, health ministries and other decision-makers to expand access to the NASG around the world. “Almost always now, people are saying, ‘We cannot let mothers die.’” Miller said. “And that has made the introduction of this device much easier…  You can say ‘Ok, if you’re interested in saving lives, here’s a device that can help.’”


Groundbreaking research proves that abortion is an extremely safe procedure

In the most comprehensive look yet at the safety of abortion, researchers at the UCSF Bixby Center found that the procedure is incredibly safe for women. In a new study published this week, Bixby Center researchers found that major complications from abortion are rare, occurring less than a quarter of one percent of procedures. This is: 

  • About the same frequency of complications as for colonoscopies. 
  • Less frequent than complications for wisdom tooth removal and tonsillectomy.

Although these new data are similar to what has been found in previous studies, this is the first study to examine complete data on all of the health care used by women who have received abortions. Since some women must travel long distances to find abortion providers, they tend to receive any needed follow-up care at facilities closer to where they live. For many women, this means their local emergency department. But, up until now, no study has systematically examined emergency department use for post-abortion care.

The researchers said they expect the study to contribute to the national debate over abortion safety. Many state legislatures have recently passed laws increasing various requirements for providers and clinics, purportedly to increase patient safety. But the researchers said that these laws were likely to make women travel further to get abortions or induce them on their own using unsafe methods, both of which may increase the risks for women. The policy debate over abortion restrictions in the United States will be better informed by weighing any theoretical and small reduction in patient risk against the increased risk to women’s health that occurs with reduced access to abortion care.